Commercial Earthquake Insurance Quote
1
General Information
2
Building/Construction Information
3
Miscellaneous Information
General Information
Insured 1
First Name
*
Last Name
*
Business Name
*
DBA
Business Address
*
Check if mailing address is different from above
Mailing Address
*
Phone Number
*
Email Address
*
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General Information
2
Building/Construction Information
3
Miscellaneous Information
Building/Construction Information
Construction Class
*
Wood Frame or Stucco
Brick Veneer
Joisted Masonary Tilt-up
Joisted Masonary Reinforced Masonary
Joisted Masonary Unreinforced Masonary
Non Combustible
Masonry Non Combustible
Modified Fire Resistive
Fire Resistive
Modular
Other
Year of Construction
Please specify the type of construction
Total Square Footage (sq. ft.)
*
Type of Parking
*
None
Detached
No Structure Above
Habitational over Garage
Tuckunder 1 Side
Tuckunder 2 Sides
Full Subterranean
Partial Subterranean
First Floor Parking
Soft First Floor Parking
Number of Stories
*
Bolted To Foundation?
Yes
No
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General Information
2
Building/Construction Information
3
Miscellaneous Information
Miscellaneous Information
Details of Building Usage/Occupancy
What is your interest?
*
Lessor
Tenant
Owner Occupant
Building Limit (100% Replacement Cost Required - No Blanket Limits)
Business Personal Property (If Applicable)
Tenant Improvements and Betterments
Deductible Amount
*
2 Percent
5 Percent
Other
Please specify the percentage
*
Business Interruption Amount
Rental Value/Income
Additional Comments
Please give any additional information you feel appropriate for this quotation. If you have additional information where there were not enough fields above, please enter them here.
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